Los Angeles Times - August 9, 2006
Erin Cline, Times Staff Writer

The study, published today in the Journal of the American Medical Assn., found that 77% of AIDS patients in sub-Saharan Africa took their drugs correctly compared with 55% of North Americans.

"The myth of poor adherence in Africa, previously used as a rationale to delay or deny the expansion of treatment programs à has firmly been debunked by this study," said Ann-Louise Colgan of Africa Action, a Washington organization focused on African issues.

Edward Mills, executive director of the Center for International Health and Human Rights Studies in Toronto and lead author of the study, said the findings should help end the practice in which patients in Africa are sometimes forced to "prove themselves capable" of following their doctors orders.

Compliance is crucial for antiretroviral therapy, which in Africa typically involves two pills a day. Not taking the medications correctly can lead to patients developing resistance to the drugs, rendering them ineffective.

Sub-Saharan Africa accounts for 10% of the world's population but 79% of AIDS deaths. In 2005, about 2.5 million people in the region became newly infected with HIV, and 2 million died, according to UNAIDS.

One example of the perception that antiretroviral drug regimens were too complicated to be effective in Africa was a comment in 2001 from the head of the U.S. Agency for International Development that African patients couldn't stick with the treatment because they didn't "know what Western time is."

Since 2003, the U.S. has undertaken a significant increase in funding for global AIDS programs through the President's Emergency Plan for AIDS Relief, which has pledged $15 billion over five years for prevention, treatment and care.

This year, the U.S. plans to spend $3.2 billion on the global AIDS fight, with $868 million specifically targeted to support antiretroviral treatment in 15 focus countries, 13 of which are in sub-Saharan Africa.

The study analyzed data from 31 previous studies involving 17,573 North American patients and 27 studies of a total of 12,116 sub-Saharan patients.

Dr. David Bangsberg, an infectious disease specialist at San Francisco General Hospital and one of the study's authors, said even though the drug regimens in North America involve more pills than in Africa, that did not account for the differences in adherence.

Mills said the scarcity of drug treatments in Africa and the big effect the drugs have on generally sicker patients probably makes them more motivated to take their drugs correctly.

In North America, where HIV has largely become a chronic instead of terminal disease, patients might lose vigilance when it comes to taking their medication, the researchers surmised.

Bangsberg predicts that adherence rates will decline in Africa as more people have access to the drugs and long-term side effects such as nerve damage begin to accumulate.

"This study makes clear what many of us have argued for a long time: that HIV/AIDS treatment is perfectly plausible in the African context," Colgan said.
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